What question did this study set out to answer?

The research aims to evaluate the efficacy and safety of intra-arterial thrombolytic agents post-endovascular thrombectomy for acute ischemic stroke.

February 2, 2026

Abstract WP002: Safety and Efficacy of Intra-Arterial Thrombolysis After Endovascular Thrombectomy for Large-Vessel Occlusion: A Dose-Wise Network Meta-analysis of Randomized Trials

Key Points

The research aims to evaluate the efficacy and safety of intra-arterial thrombolytic agents post-endovascular thrombectomy for acute ischemic stroke.
Analyzed randomized controlled trials comparing EVT alone vs EVT plus IA thrombolysis.
Searched multiple databases for studies up to October 2025.
Primary outcomes measured included functional recovery (mRS 0-1) at 90 days and safety outcomes (ICH, mortality).
Utilized random-effects frequentist network meta-analysis with odds ratios calculated.
Eight RCTs with 2,148 patients showed improved functional independence with EVT plus alteplase and tenecteplase.
Alteplase 0.225 mg/kg increased functional independence (OR 1.98), while Tenecteplase 0.125 mg/kg also showed benefits (OR 1.90).
No increased risk of intracerebral hemorrhage was found with IA agents across seven RCTs.
Mortality rates were similar between IA thrombolysis regimens and EVT alone in six RCTs.

Abstract

Background: The benefit of adjunct intra-arterial (IA) thrombolysis post endovascular thrombectomy (EVT) for acute ischemic stroke remains unclear. We aim to compare the efficacy and safety of IA thrombolytic agents used in post-EVT, with particular attention to dose variation. Methods: We included randomized controlled trials of adult patients with large-vessel occlusion stroke that compared EVT alone with EVT plus IA thrombolysis. PubMed, Scopus, Embase, and the Cochrane Library were searched for relevant studies (up to 10/08/2025). The primary outcome was excellent functional recovery (modified Rankin Scale mRS 0–1 at 90 days). Safety outcomes were intracerebral hemorrhage (ICH) and 90-day mortality. Odds ratios were calculated using a random-effects frequentist network meta-analysis with the DerSimonian Laird estimator. Language refinement was assisted by ChatGPT (OpenAI, GPT-5). Results: Eight RCTs (n=2, 148) informed functional independence (mRS 0–1 at 90 days). Compared with EVT alone, EVT plus intra-arterial alteplase 0. 225 mg/kg significantly improved functional independence (OR 1. 98, 95% CI 1. 35–2. 92, p=0. 0005), and EVT plus Tenecteplase 0. 125 mg/kg also showed benefit (OR 1. 90, 95% CI 1. 12–3. 23, p=0. 017). Other regimens did not achieve statistical significance. For safety, seven RCTs (n=1, 844) demonstrated no increased risk of intracerebral hemorrhage with IA agents (e. g. , alteplase OR 0. 27, 95% CI 0. 03–2. 15; urokinase OR 1. 00, 95% CI 0. 43–2. 35), while IA tenecteplase 0. 0625 mg/kg showed a nonsignificant trend toward higher ICH (OR 1. 76, 95% CI 0. 94–3. 28; p=0. 076; I²=0%). Six RCTs (n=1, 804) demonstrated no significant mortality difference across IA thrombolysis regimens compared with EVT alone. Heterogeneity and inconsistency were low across analyses (I² = 0%). Conclusions: Adjunctive IA Alteplase and Tenecteplase after EVT improved functional recovery with no increase in ICH or mortality, and higher dose Tenecteplase appeared to yield a superior outcome compared to lower dose, underscoring the need for larger trials to refine optimal regimens. Keywords: Endovascular thrombectomy, Intra-arterial thrombolysis, Acute ischemic stroke

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